The medical community is embracing cloud-based technology. Will general dentists make the leap?
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By Kelly Rehan
Since 2016, organizations across industries have been transitioning their data to the cloud, and hospital systems and medical practices are beginning to follow suit. But why isn’t cloud-based EHR technology more prevalent in dentistry? What will it take for general dentists, in both big and small practices, to adopt it? 12
Self-Instruction article, 1 CE credit
By
Eric G. Jackson,
DDS, MAGD, FICOI, FASD, FICD, FADI Achieving effective and efficient communication among all members of a dental team is one of the most important aspects of any successful practice. But why does stellar communication remain so elusive an achievement in many dental practices?
20 Exercise No. IM149, 1 CE Credit Electronic Health Record and Policies Subject Code: 567
The best clinical doctors are not necessarily the most financially successful. They are the dentists who create the best rapport with their patients. Creating a positive and comprehensive experience is important to meeting patients’ expectations and having them accept treatment. Effective communication also helps develop trust and creates loyal relationships.
Dentists need to focus on improving their patient communication skills from day one in practice, regardless of their clinical setting. Impeccable chairside manners can be a tremendous advantage that complements technical training. The patient needs to become part of the process. Interpersonal relationships are established when you empower the person in your chair to make informed decisions based on your best clinical evaluations.
Prior to my initial examination, differential diagnosis and treatment plan, I sit down faceto-face with my new patient. I tell them that I want to make sure they are comfortable with my team and that everyone has treated them well — from the initial phone call to scheduling to being greeted when they first enter my reception area. Once that is established, I introduce myself.
I assure them that my job is not to sell anything, but rather to educate and instruct as to the benefits of my talents and experience. But communication has to go both ways. The patient needs to be comfortable telling me how they feel and what their ultimate goals and expectations are. Being in a new office with a new dentist can be challenging and difficult for any person. Having an empathetic staff really helps make the patient feel at ease. Again, I sit and discuss why the patient is here. Are they in pain? How did they find us? What immediate concerns do they have, and what are their long-term goals? Discussing particular concerns and addressing them first establishes confidence. Obviously, all individuals may not know the intricacies of what we can provide, but they may have some broad concepts of what they desire. Cost is
not the issue at this stage; rather, developing some form of rapport is paramount. Dialogue needs to proceed in terms understood by the public. Being too technical or scientific can be confusing, but the person will not necessarily acknowledge that they have no clue what we are talking about. I do not discuss any financial responsibilities. This is done in a private setting with my treatment coordinator. I do tell the patient that my job is to provide exceptional care, and the staff’s job is to make things affordable. Everyone is on a budget of some sort, especially in these times, so meeting the patient’s ability to pay for treatment is important.
These interactions put control of therapy in the mind of the person sitting in the dental chair and can make them feel satisfied with a positive dental experience. Satisfied patients refer similar individuals and become loyal advocates. Making sure that there is a constant open dialogue between the patient, staff and doctor helps resolve any negative issues that could arise. In my practice, all treatment is written down and explained to the patient prior to any physical work. There should be no confusion on what they should expect and receive.
As I mentioned before, the team is an integral part of our success. I surround myself with employees who are empathetic, friendly and experienced enough to answer many of the questions that relate to treatment once the dentist is out of the room. Effective intraoffice communication is also integral — it’s a topic discussed in this month’s feature story.
Making the patient a part of the decision-making team is critical. They help direct me to the results they desire and expect. Communication breaks down when we do not meet their expectations. The patient should always feel that they are in control so that they move forward without any buyer’s remorse. Talking “with” and not “to” that human being reclined in our dental chair can go a long way.
EDITOR
Timothy F. Kosinski, DDS, MAGD
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Bruce L. Cassis, DDS, MAGD
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On May 22–23, 2023, AGD leaders from around the country descended on our nation’s capital to petition the government on behalf of general dentists.
First, attendees heard from policy leaders such as Rep. Larry Buchon, MD, from Indiana; Rep. Drew Ferguson, DMD, from Georgia; and Natalia Chalmers, DDS, MHSc, PhD, the chief dental officer at the Centers for Medicare & Medicaid Services.
Then, they learned about the issues they would discuss with their legislators: support for the Oral Health Literacy and Awareness Act 2023 (S. 403/H.R. 994), support for the Strengthening Medicaid Incentives for Licensees Enrolled in Dental (SMILED) Act (H.R. 1422), and, finally, urging Congress to ask the Department of Justice to enforce the Competitive Health Insurance Reform Act of 2020 (CHIRA).
Sen. Ben Ray Luján (New Mexico) and Rep. Tony Cárdenas (California) were awarded AGD Legislators of the Year for their sponsorship and leadership of the Oral Health Literacy and Awareness Act 2023.
Finally, attendees visited their representatives’ and senators’ offices to discuss the three issues with legislators and staff and offer themselves as expert resources on dental policy.
The reception from the Hill was positive, with many offices expressing support for AGD’s initiatives. AGD’s Washington representatives will build on the momentum generated by Hill Day during this session. You can help by contacting your legislators whenever AGD sends out an action alert. Visit agd.org/advocacy for more information.
AGD fact sheets provide your patients with all of the information they need to maintain their oral health. Fact sheets on more than 25 oral health topics are available for downloading online and can be customized to include your name and practice information. Download the fact sheet “Restoring Smiles with Dental Implants” at agd.org/factsheets.
Featured Podcast: Taking Dentistry to the Next Level with Tarun Agarwal, DDS
Tarun Agarwal, DDS, speaks on the AGD Podcast Series about how to maximize your dental practice and career. Agarwal understands the challenges solo practices face — dental insurance fees, competition from large dental groups and internal struggles. But he still believes that dentistry is the best profession in the world, with more opportunity than ever. He uses a commonsense approach to sustainable practice growth. He focuses on clinical excellence, patient-centric business management and a dental team empowered to embrace an ownership mentality.
Visit agd.org/about-agd/publications-news/agd-podcasts to listen now.
AGD is proud to share this year’s Student Chapter and Faculty of the Year award winners.
The Student Chapter of the Year Award honors one AGD student chapter that provides its student membership with the best overall set of programs and activities. This year’s winner is the Louisiana State University (LSU) School of Dentistry AGD Student Chapter. This chapter worked hard to recruit 75 new members and host nine continuing education sessions. It also expanded its chapter offerings and began hosting general meetings for student members. LSU AGD found ways to give back to the community as a group, including its World Mental Health Day event, which featured a “paws”-itivity board and therapy dogs.
The Faculty of the Year Award honors one AGD student chapter faculty adviser who provides their chapter with the best overall support and guidance. This year’s recipient is Jon M. Dossett, DMD, MAGD, ABGD. One of his students shared the following:
“Dr. Dossett brings a wealth of experience and leadership to the University of Texas Health Science Center at San Antonio Dental School’s Student
FellowTrack AGD organization. He is very easy to approach about any issues, whether academic, personal or regarding our other activities in the profession. I’ve found him to be an excellent mentor, not just to me and our student executive board, but also to every student seeking his advice.”
For more information on AGD student chapter awards, contact students@agd.org
Washington is home to one of the most active AGD constituencies. Through Washington AGD’s guidance, mentorship and financial support, the University of Washington School of Dentistry (UWSOD) AGD Student Chapter has created some innovative opportunities for students to experience all AGD has to offer.
Under the leadership of James E. Newman Jr., DDS, MAGD, ABGD, clinical assistant professor; and Jason Lu, chapter president, the UWSOD AGD student chapter has created numerous continuing education (CE) opportunities for its student members. This includes up to three CE programs and one social event per quarter. The UWSOD graduate prosthodontics program and its director, Van Ramos, DDS, provide a prosthodontic lecture by one of the graduate prosthodontics residents every quarter. The chapter also selects another speaker to present on a relevant topic. Another CE event the chapter attempts to host every quarter is a live hands-on event. Attendance continues to grow, and the UWSOD AGD Student Chapter CE opportunities are now being extended to dentists in the community as well, often being hosted at the Washington AGD Global Learning Center (washingtonagd.org).
In 2019, the UWSOD AGD Student Chapter launched the now annual course, “Crown Preparation 101: From Analog to Digital,” mentored by Timmy A. Hess, DDS, MAGD. On May 20, 2023, with support from Komet USA, NSK, Ivoclar, Planmeca, Diashine, Pascal and Washington Dentists’ Insurance Agency, 27 students were led through the “38 Steps of a Crown Preparation.” Karl Hoffman, DDS, and John Yae, DDS, demonstrated and supervised the procedures throughout the day. This CE experience, being a guided hands-on course, attempts to create a logical workflow, from seating the patient through buildup, preparation, impression/scanning, provisionalization and, finally, releasing the patient. Students began the day thinking a crown preparation course is about burs and typodont teeth and left realizing there is much more when there is a patient in the equation.
The UWSOD AGD Student Chapter plans to take this course to other dental schools and meetings. Future UWSOD AGD StudentTrack course offerings will include David Clark, DDS, teaching composite restorations based on the Bioclear Method. More digital dentistry is coming, and the UWSOD AGD Student Chapter members continue to have access to the Washington AGD Fellowship and MasterTrack course at the Washington AGD Global Learning Center at greatly reduced tuition costs.
The American Association of Dental Consultants’ (AADC’s) annual Spring Workshop was held in Phoenix, Arizona, May 3–6, 2023. AGD was among the organizations sponsoring continuing education programs at the session that was attended by more than 200 individuals.
AADC is the professional association for dental benefits consultants who review and adjudicate dental claims to ensure compliance with the specific requirements of the subscriber’s plan. Meeting attendees work for a variety of employers, including private plans and government-sponsored plans such as Medicaid and Medicare.
Guy E. Acheson, DDS, MAGD, a consultant to AGD’s Dental Practice Council, delivered the course, “Digital Dental Photography: More Than Just Pretty Pictures.” The course was designed to educate AADC members about the value of using this technology to educate patients about their conditions, serve as a valuable resource when presenting recommended treatment, support claims processing, resolve patient questions about treatments performed and support the dentist’s records in legal conflicts.
Highlights of Acheson’s presentation included a demonstration of what constitutes good-quality dental photography, a review of available camera systems and tips on obtaining excellent dental photographs, and how he uses dental photography in his practice and how it has significantly reduced the number of claims rejected by third-party payers. The program also included a review of CDT Codes relevant to reporting the use of photography.
According to Acheson, “Before developing my presentation, I spoke with several colleagues who work for dental insurance companies. Each of them expressed gratitude for those instances when claims included digital dental photographs, since that additional information provides firsthand evidence of the need for the dental procedure reported. Even a single good-quality photograph of an unsupported cusp or dark-stained crack in a tooth really helps validate requests for procedures such as build-ups and full-coverage restorations.” Acheson also reported that, even though the program allowed time for questions and answers, he was approached by several people after the course who had additional questions or who wanted to share their own positive experiences with digital dental photography.
Also attending the meeting were AGD Treasurer Joseph A. Picone, DMD, MAGD, and AGD Past President Bruce L. Cassis, DDS, MAGD, who introduced Acheson’s course to attendees. “Guy presented an excellent program that really captured the audience’s attention,” said Cassis. “AGD’s sponsorship of a course at this meeting is a real win-win scenario: Attendees learn about procedures performed by general dentists and the value of those treatments to patients, and AGD is acknowledged as the only professional dental association that exclusively represents the interests of the general dentist.”
The overall program for the 2023 Spring Workshop featured sessions on the use of artificial intelligence in claims review and also on the claims review process from the dual viewpoints of the dentist filing the claim and the third-party payer who is required to ensure compliance with the plan’s guidelines.
AGD plans to continue its collaboration with AADC to provide the dental consulting community with informative educational programs that increase their awareness of procedures performed by general dentists and their role in improving patients’ oral healthcare.
Four AGD Executive Committee officer positions will be on the ballot at the Nov. 10–12 House of Delegates annual meeting in Chicago. Those positions are vice president, secretary, speaker of the House of Delegates and editor. Vice president is a three-year commitment with automatic ascension to president-elect and president. Secretary is a two-year term with the possibility of reelection for an additional term. Speaker of the House of Delegates is a two-year commitment with the possibility of reelection for two additional terms. The editor serves a term of three years with the possibility of reelection for two additional terms. AGD’s Election Guidelines and Bylaws contain a job description of each of the aforementioned offices, and the nomination petition can be found on agd.org by navigating to “About AGD,” then “Leadership/Governance,” then “Leader Resource Center.” Questions should be directed to Daniel Buksa, JD, CAE, AGD associate executive director, at 888.243.3368, ext. 4328 or daniel.buksa@agd.org
Look for the following articles in the July/ August issue of AGD’s peer-reviewed journal, General Dentistry.
• Intranasal delivery of medications: opportunities for dentistry
• Accuracy of an intraoral scanner based on sleeve type, decontamination, and calibration
• Polyetheretherketone materials for removable partial denture frameworks: an integrative review
To view past issues, visit agd.org/generaldentistry.
Look for the Newest ‘Daily Grind’ Blog Post AGD’s blog, “The Daily Grind,” offers insight and reflections from dental students and practicing general dentists. “Moments of Magic” is a series by Larry Stanleigh, BSc, MSc, DDS, FAGD, FADI, FICD, FACD, FPFA, that outlines 10 moments that can change how patients respond to your dental practice.
Visit “The Daily Grind” to read about how to implement these Moments of Magic into your practice: agd.org/ daily-grind.
By Roger P. Levin, DDS
Dental practices are complex small businesses. There are hundreds of steps and components for each practice system, and they need to operate efficiently and effectively to maximize practice potential. As owners and managers, dentists have a clear responsibility regarding practice development and success; however, they must spend most of their days focused on patient care. Is there a model that can be followed that will result not only in successful practices, but also in high levels of efficiency and low levels of stress?
Dentists have worked extremely hard to go through dental education, and many have exorbitant student loan debt. Many will endeavor to own their own practices, but even dentists who choose to be employees want to experience high production, excellent incomes and low-stress environments. This column will focus on the three aspects of building extraordinarily successful dental practices.
You may be thinking: “Here we go again. Another article about having a vision.” But there is a reason having a vision is frequently discussed in business schools and the business world. Establishing a vision is a basic and grounded method of answering the question about where you want to be in five years.
In a recent conversation I had with a dentist, he expressed his concern regarding multiple opportunities and not knowing which ones were wasting his time and which were actually valuable. These included buying a building, buying two practices in two different locations, and renting space in another practice where he would have the opportunity for significant referrals for a specific service. I explained that the first step was to establish a vision. Without a vision, he would be operating like a proverbial pinball machine, bouncing into everything that was coming at him and hoping that something would stick. He was also missing opportunities because he was not proactive in seeking them.
Establishing a five-year vision would give him a chance to benchmark all opportunities that presented themselves against that vision. Then, and only then, could he determine whether an opportunity was the right fit. Further, it would guide him in proactively seeking opportunities that would fit his vision. Most importantly, it would keep him from being distracted and making mistakes that could set him back years.
Not every dentist or practice has a desire to access external opportunities. However, the concept of establishing a five-year
vision and knowing where you want to go and when you want to get there is just as relevant in a single practice location as it is in a larger group. Furthermore, it’s just as relevant in a decision to purchase real estate as it is in a decision to rent. For example, some experts advise against renting. However, owning real estate may or may not be relevant to your vision, and those funds could be used for other parts of the vision. In other cases, owning real estate makes perfect sense. When it comes to a vision, there simply is no rule of thumb.
The best businesses have the best systems. If you look at competing Fortune 500 companies, the ones that do best in the long term are the ones that typically have the best systems. Procter & Gamble, for example, does tremendous research, market analysis and testing before it launches a product. It is one of the most successful companies and is over 100 years old. It has watched competitors come and go, and it has even sold off divisions and avoided competing with them because its systems and methodologies are so exacting that it rarely makes major mistakes.
Dental practices are no different. The best practices have the best systems. After 38 years of serving practices, I can tell almost immediately how successful a practice is by understanding its level of systems. The best practices are highly organized; team members are trained and know exactly what they need to do, and they carry out their tasks daily. These teams gradually begin to work independently, and even if there is an office manager, that individual can work at a higher level in areas of practice growth, development and strategy. Moreover, the office manager becomes more focused on helping to achieve the vision than micromanaging the rest of the team because the rest of the team has systems, documentation and steps to follow.
Component No. 3: Leadership Leadership is another area that is constantly talked about. But what is leadership? It is making other people successful.
In the case of the dental practice, those “other people” are the team. I mentioned before that we would like team members to develop and work independently, but I didn’t mention that leadership is about explaining and clarifying exactly what results are expected. The purpose of creating systems is to get a specific result, but it does not always happen. If you want great results, people need to know what the expected results are.
How does a leader help the team process what it has or has not achieved as individuals and collectively? One of my favorite recommendations to dentists and office managers is to stop managing and start measuring. It’s no different than for the coaching team of an elite athlete. An Olympic runner does not get to say that they’re on pace to set a world record. They have a coach with a stopwatch who measures their time and progress.
Think of your team as corporate athletes. If they can’t be measured in most of their tasks, they’ll never know how they’re doing. In fact, we have seen many instances in which team members believe that they are doing a great job, yet their performance is actually average or poor.
Here are a few examples of measurements and targets:
• 96% of active patients are scheduled for their next appointments.
• No-shows are under 2%, including last-minute cancellations.
• 98% of money owed within 30 days is collected.
• The practice gains 30 new patients per month (or 40, 50 or 60).
If the team is not measured, you have a problem because you don’t really know how you’re doing. Another of my favorite business expressions is: “What gets measured gets done.”
Summary
Dentistry is a complex business, but you can make it less challenging and more satisfying by implementing three key business components. Every practice should take the time to develop a vision, implement systems and set measurements. Practices that follow this process are typically more organized and productive and experience far less stress. F
Roger P. Levin, DDS, is the founder and CEO of Levin Group, a dental management consulting firm. To receive his Practice Production Tip of the Day, visit levingroup.com. To comment on this article, email impact@agd.org.
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We all know that effective intraoffice communication is crucial. Yet, occasionally, we still fail to do so properly. There are many aspects to balance as a dentist, and communicating with our team can easily become a lower priority than it should. Prioritizing time to have uninterrupted discussions at work can help us achieve the success we’re aiming for every day. A great way to accomplish this is with a morning huddle.
The morning huddle is essentially a gathering of your team members for a brief but focused check-in so that everyone can be on the same page. You can identify potential issues before they become major roadblocks, discuss cases, share ideas and best practices, and build relationships. The effectiveness of this meeting depends on how it is conducted. You, as the leader of your office, need to ensure the discussion is limited to what is relevant to the goals for the day. Huddles should also be held at a consistent time and place every day to ensure everyone can attend and plan accordingly. This often means everyone arriving at work a little earlier than normal.
In my experience, asking or making employees come to work before they’re used to is like pulling teeth (pun intended) — especially for a meeting that many individuals may initially view as time-consuming or pointless. It is up to you as the leader to create the right structure of the meeting that matches the culture of your office. Properly introducing and structuring these meetings will make them feel useful and worthwhile.
If you’re considering implementing morning huddles, it may be helpful to start with a trial period and gather feedback. You can then adjust the time and format based on any suggestions. A great place to start is discussing with your team what you want to achieve with these huddles and then deciding as a group what to name them.
Here are some ideas on where to begin creating your morning huddle:
• Pick a reasonable start time and duration. In my opinion, the meeting shouldn’t be more than 10 minutes, especially if it’s daily. Allow enough time before or after for your staff to set up rooms, check patients in and prepare to see patients on time. For example, if the first appointment is at 8 a.m. and your team needs 15 minutes to get the office ready each morning, begin your 10-minute morning huddle at 7:35 a.m.
• A good item to start with is the day’s schedule. Review any notes or patients who require special attention or care, such as those
with dental anxiety or medical conditions that could affect their treatment. This can also include details about certain patients to ensure they feel welcome and included in your office, such as recent birthdays, vacations, life achievements, or even their pronouns or nicknames.
• Establish goals for the day, such as improving patient satisfaction or reducing wait times. Identify any potential obstacles that may prevent these goals from being met, and discuss strategies to overcome them.
• Acknowledge accomplishments and celebrate any successes from the previous day or week, such as positive patient feedback or meeting production goals. Public praise for an individual can go a long way, but make sure it’s genuine. Be specific. This will help motivate the team and create a positive atmosphere.
• Address any issues, but do not publicly scold or acknowledge the mistakes of an individual. This will start the whole day on the wrong foot. If there are any issues from the previous day, discuss them and come up with solutions to prevent them from happening again. This could include problems with equipment or communication breakdowns between team members.
• Finally, end the huddle on a positive note by reminding everyone of the importance of teamwork and patient care. My favorite way of doing this is by picking a new inspirational or motivational quote to begin our day. I learned this from one of my mentors, and it has made a positive impact on my life since then.
A productive morning huddle can help improve communication, increase transparency, and foster a sense of teamwork and accountability. By following these tips, you can help create a positive and productive environment that benefits both patients and the dental team. F
Why are we discussing your emotions in a professional article? You may have been led to believe that professionalism demands the subjugation of your emotions. But think about it — your emotions impact your behavior, and your behavior impacts your effect on others. Regrettably, your effect on others is not always positive. Understanding how to express emotions effectively can result in improved relationships with your staff, your patients, your colleagues, your friends, your family and, most importantly, yourself.
The most difficult part of learning how to express emotions effectively is developing the ability to identify what you are feeling. Emotions can disguise themselves. Sadness can disguise itself as anger. Fear can disguise itself as disgust. If you express an emotion that you have misidentified, your words and actions will be the basis for interpretation and reaction by others and may set in motion a long thread of miscommunication.
Sometimes, your body behaves in a way that indicates you are in a heightened emotional state, but you cannot identify the emotion behind the physical reaction. If you are unsure of what emotion you are feeling, you may find it helpful to think about what precipitated your feeling this way. Did you have a conversation with someone? Did you hear some news? Were you overwhelmed by a memory? Thinking about what precipitated the feeling may help you discern not only what emotion you are feeling, but also why you are feeling that emotion.
Maybe texting culture can help you accurately identify what emotion is affecting you. Think of the emoji you would attach to a text to express what you’re feeling right now. What does that emoji tell you about the emotion that you’re feeling?
When you’re identifying what you’re feeling, try to dig down a little deeper than usual. You’re feeling something and reacting to it, but is your behavior an accurate expression of your emotion, or is it simply your default method of expression? Some people act out rage when they’re sad. Some cry when they’re anxious. What emotion is truly the source of your behavior?
This process of identifying your emotions is a skill, and, like any skill, it must be honed. Think about physical exercise and how you often avoid the areas that need the most work. If you’re not accustomed to identifying your emotions, it’s likely that you’re comfortable pushing them away or holding them back, which makes identifying them particularly challenging. Your first step might be to understand that feeling an emotion doesn’t mean
you need to succumb to it or be overcome by it. All you need to do is identify the emotion you’re feeling. You’re sad. You’re happy. You’re fearful.
Once you know what the emotion is that you’re feeling, you can use basic communication skills to express your emotions effectively. At a minimum, you can simply state how you’re feeling to others so that they can frame your behavior in the proper context. A simple disclosure like “I’m sad today” can inform your colleagues of why you’re not your usual effervescent self and can preclude the mistaken impression that your demeanor or behavior has anything to do with them.
If the behavior of another has generated a negative emotional reaction on your part, you may need to employ conflict resolution skills. Keep the conversation focused on yourself and the specific behavior that elicited your emotional reaction. Explain how that specific behavior made you feel, what alternative behavior you would prefer in the future, and how you think that would benefit all involved. Allow for some reaction time, and understand that this may be the first of many similar conversations before a change in behavior is effected.
Verbal communication is not the only method of expressing emotions. You can also use creative outlets such as music, art and dance to express your emotions to others. Keeping a diary or journaling allows you an opportunity to express your emotions privately.
Once you have honed the skills of identifying your own emotions, you may be able to use these skills to help you sort through the behavior of others to understand what emotions they are feeling. However, few people enjoy being told what they are feeling, so we don’t advocate that you try to reassure them by helping them to identify their emotions. Instead, you can use your insight to help yourself react to those in heighted emotional states with understanding, compassion and patience.
At this point, we hope it’s clear that subjugating emotions does not equate with professional behavior. Rather, identifying your emotions and communicating them effectively to those around you increases professionalism by permitting others to conceptualize your behavior within the context of your expressed emotions. As a bonus, you may experience a reduction in your levels of frustration and stress once you learn to identify and communicate your emotions effectively. F
Eric S. Studley, DDS, is the president and CEO of Eric S. Studley & Associates, an insurance brokerage company specializing in the insurance and financial needs of dentists. Ivy D. Peltz, DDS, MSEd, PhD, MAGD, is retired from private practice in New York City. They are both retired from academic positions at the New York University College of Dentistry. Together, they co-founded Doccupations, the dental career services component of Eric S. Studley & Associates. To comment on this article, email impact@agd.org.
Several qualities are common among great mentors: patience, compassion and good communication skills. Perhaps the most defining quality, though, is the desire to both pave the way toward a common goal and ensure that others can walk the path behind you. As founder of the Determined to Be a Doctor Someday (D.D.S.) program, Christina T. Rosenthal, DDS, MPH, exemplifies all of these qualities. Under her leadership, the D.D.S. program is changing the face of the healthcare professions by establishing pathways for children in underrepresented communities to one day become doctors. Rosenthal is also the author of a children’s book, “You Can Become a Doctor Too,” which was inspired by her work with toddlers through the D.D.S. program. She spoke with AGD Impact about why she developed the D.D.S. program and how other AGD members can get involved.
AGD Impact : What is the Determined to Be a Doctor Someday (D.D.S.) program?
Rosenthal: Designed to expose students of any race and ethnicity who are underrepresented, under-resourced, and who are from rural communities and/or first-generation backgrounds to various fields of healthcare, D.D.S. is a pathway initiative that seeks to inspire students and place them on the journey to becoming doctors (determinedtobeadoctor.org). D.D.S. programming consists of an annual symposium, a six-month educational program, virtual events, scholarship opportunities, standardized test preparation, personal development and mentorship connections in various healthcare professions. Our “future doctors” are exposed to the technical aspects of the professions, but, more importantly, they are given insight into the individual stories of determination and resilience from our healthcare provider guest speakers. The overarching goal of D.D.S. is to help close the health equity gap witnessed in many communities by developing a diverse generation of healthcare practitioners who are reflective of those they serve. Our student groups served are toddlers ages 2–5 and teens ages 14–18, with programming currently being developed for the age groups in between.
What inspired you to start this program, and what hurdles have you had to overcome in setting it up and running it?
As someone who grew up in an impoverished community, I have always desired to give back and show others the possibilities. This opportunity was created for me when I participated in the American Dental Association’s (ADA’s) Institute for Diversity in Leadership from 2010 to 2011. As an institute requirement, I had to create a program to benefit my community, and D.D.S.
was born. I never anticipated the demand that would be created from our first event. One of the biggest hurdles in running it has been the competing tasks of owning a private practice and also being a wife and mother, but I was so grateful to have a team and family who all pitched in to help. Funding was also a challenge. Initially, besides the ADA seed funding, I spent personal funds to operate it. As I witnessed the difference it was making with the students we were serving, my level of commitment was elevated. With the help of the University of Tennessee Health Science Center, Delta Dental of Tennessee, individual donors, and, more recently, Waterpik Oral Health, our organization has been able to thrive and increase the number of students we serve. There is still so much work to be done, and community partnerships are critical to our long-term success.
With a name like Determined to Be a Doctor Someday, the most obvious impact this program has is its influence on the participants’ individual journeys. There are some careers that students never considered because they did not know they existed. There are also students who apply or attend professional school who did not have a close relative or friend take the journey before them, so we serve as a continuous point of reference to help them navigate the process. Then, there are the smaller yet impactful wins — students who achieve improved academic performance, who obtain high standardized test scores, who get full rides to college, and who boast of being more hopeful about their future, as well as the connections made among like-minded peers and/or mentors. Although our program is inclusive and seeks to improve representation in all healthcare fields, we are proud that many of our students have chosen and are
pursuing the profession of dentistry. They will truly be assets to the profession.
What stories from graduates of the program stick with you?
One of the most beautiful outcomes of the D.D.S. initiative is the desire of former participants to return to give of their time and/or resources. Many who enter college return to help with our events. Those in professional school or who are now doctors often return to speak. More recently, Quodarrius Toney, DDS, a dentist who was a student in our inaugural program cohort, highlighted our program on “Good Morning America” and surprised our organization with a donation. It was such a full-circle moment!
What can AGD members do to help support the D.D.S. mission?
There are many ways support can be given to the D.D.S. mission. The work of our organization can benefit youth in communities across the United States, and hosting a symposium in your city could be an avenue of support. Volunteering time or talents is always appreciated. Financial contributions remain a great resource to continue the mission. Last, but certainly not least, by engaging with our social media channels and sharing our message with their followers (Facebook: Determined to be a Doctor Someday, Twitter and Instagram: @TheDDSProgram), AGD members can share our vision with a larger audience. F
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As someone who grew up in an impoverished community, I have always desired to give back and show others the possibilities.Top left: Dr. Quodarrius Toney, former participant of the D.D.S. program, presents Rosenthal with a surprise donation on “Good Morning America” with correspondent Alex Perez. (Photo credit: University of Tennessee Health Science Center.) Top right: Rosenthal with her children’s book. Bottom: Toddlers of the D.D.S. program all prepared for “surgery day,” where they get to dress up and operate on “patients” and learn about the different body systems.
In April 2023, Aspen Dental announced that a cybersecurity event affected all of its more than 1,000 practices. One of the largest dental services organizations (DSOs) in the United States, Aspen Dental has more than two million patient dental records that may have been compromised.1
Aspen Dental uses electronic dental records that are self-managed at a centrally maintained server base, allowing all of its offices to access the record of any Aspen Dental patient. But having that data locally stored as opposed to cloud-based may have put the DSO at risk, said Edward J. Zuckerberg, DDS, FAGD, who lectures nationally and internationally on technology integration.
“Any dental practice, big or small, not using a major cloud-based electronic health record (EHR) is prone to these
cyberattacks,” Zuckerberg said. “Chances are that hackers will target big fish over small fish, but there is money in small fish. And they’re easy to crack.”
Is implementing cloud-based technology an antidote to the security issues that can keep dentists up at night? Many healthcare technology experts say yes, and the medical industry’s adoption of cloud practice management solutions may offer a glimpse of what’s to come in the not-too-distant future of dentistry.
Since 2016, organizations across industries have begun transitioning their data to the cloud,2 and hospital systems and medical practices are beginning to follow suit. A 2023 study of 500 healthcare IT professionals found that 70% work in organizations that already use cloud technology, with an additional 20% intending to do so within
The medical community is embracing cloud-based technology. Will general dentists make the leap?
the next two years. Medicare and Medicaid facilities (91%) and hospitals (90%) had the highest cloud-based technology adoption rates, while dental practices (23%) had the lowest. Doctor’s offices were at 37%.3
The benefits of the cloud over a local network aren’t limited to enhanced security. Greater interoperability with colleagues across sites and specialties, potential reduced cost, and artificial intelligence (AI) offer exciting opportunities to improve patient care and increase efficiencies in the practice environment. So, why isn’t cloud-based EHR technology more prevalent in dentistry?
What will it take for general dentists, in both big and small practices, to adopt it?
Before exploring cloud-based EHR use in dentistry, it’s important to examine its established and evolving role in medicine.
In terms of EHRs, “moving to the cloud” means that healthcare facilities use off-site
servers to store and manage their data, and they access that data through the internet.4 Moving to the cloud also means you shift data management responsibilities to a third party, Zuckerberg said.
“The company that hosts your data does everything for you — all updates are done by vendor,” Zuckerberg said. “You don’t have to be in your office to access the data; you can get full access to your entire complement of data anywhere.”
With medical EHRs, there is a differentiation between how the software is accessed and where the data is stored, explained Mark W. Jurkovich, DDS, MBA, MHI, MAGD, director of data infrastructure for the Health Care Systems Research Network.
“Most installations still store data locally or use a separate cloud storage capability that is not necessarily associated with the software itself,” Jurkovich said. “What’s most typical is that information is stored locally using onsite servers, and we back it up to the cloud.”
An important distinction is that EHR providers are separate from cloud hosting providers. Customers have the option of selecting an EHR provider and then separately contracting with a cloud service provider to house their data, or they can opt to take advantage of an established partnership between an EHR provider and cloud provider. The benefit of the established partnership is that the integration between the EHR and cloud providers will be thoroughly tested for security and effectiveness, so you’ll have more peace of mind knowing that you have a trusted connection between your software (EHR) and hardware (cloud). Examples of partnerships include Oracle Cerner and Amazon Web Services, and Epic and Google Cloud5 and Microsoft Azure.
“You can get Epic and partner with another [cloud] vendor, but getting the partnership of Epic and Microsoft means you’re joining an environment that adheres to industry-standard best practices in data security and is proven to work,” said Jacob
Several leading EHR companies have said their goals are to create a “nationwide health IT infrastructure.” There have been multiple attempts to create a national government or professionally managed healthcare record system that would consist of regional healthcare information exchanges, but many of these efforts have not come to fruition and/or remain at the local level. This is, in part, due to American cultural values surrounding privacy and healthcare, but it also has to do with costly business and technology complexities of organizing disparate data sources, providers, vendors and staffers into a single integrated system, said Jacob Krive, MBA, MS, PhD.
“It remains a bit of a myth for now,” Krive said. “It’s a great idea, and there are nationwide infrastructures in other countries.
But in the United States, we are raised with the idea that your patient record is private, and we primarily see private healthcare professionals — with the exception of Veterans Affairs.”
The technical requirements of organizing a nationwide health IT infrastructure are also complex, though not as daunting as the political and business barriers, Krive said.
Source: Dyrda, Laura. “Judy Faulkner: Epic Building a ‘Nationwide Health IT Infrastructure.’” Becker’s Hospital Review, Becker’s Healthcare, 29 Aug. 2022, beckershospitalreview.com/ehrs/ judy-faulkner-epic-buildinga-nationwide-health-itinfrastructure.html.
One of the benefits of cloud-based EHRs is their ability to provide clinicians access to huge volumes of data. One way that providers, including dentists, can further leverage data is by participating in a cloud-based data warehouse.
“Data warehouses will be the tool dentistry will use to truly understand medical-dental integration, and it will also lead us to develop decision support tools that we don’t have in dentistry right now,” said Mark W. Jurkovich, DDS, MBA, MHI, MAGD.
Decision support tools tell clinicians the tests they may want to order or the type of information they should gather from the patient, for example. Data warehouses leverage large volumes of data that are shrunk into smaller groups, helping guide clinicians in the right direction.
“In dentistry, we have the strong belief that diabetes and periodontal disease go together, but we don’t know exactly what type of diabetes, and we don’t know if it’s mild or severe periodontal disease,” Jurkovich said. “But if we had more information, we would.”
Many of the big players in cloud-based EHR technology offer data warehouses. For example, healthcare systems that use Epic can elect to participate in Epic Cosmos, where their data is uploaded to a common data warehouse in which it is standardized and de-identified. Any participating site can then use this large amount of data to perform research and develop decision support tools, said Jurkovich.
“Epic Cosmos can do that research because they’re combining hundreds of thousands of records. Many of these systems are also
working with other types of data warehouses, like OHDSI.org, which is a research data warehouse with patient records from all over the world that are de-identified.”
There are dental-specific data warehouses, Jurkovich explained. One is the BigMouth Dental Data Repository, which is managed by the University of Texas Health Science Center at Houston. Another is the American Dental Association’s Dental Experience and Research Exchange (DERE)TM. Tab32, a dental cloud-based platform, also offers an open data warehouse.
Data warehouses are an advantage to dentistry, Jurkovich said, because anyone can participate and submit information. Ultimately, more data will lead to decision-support tools for dentistry. But, for now, participants can leverage a dashboard to provide practice benchmarks and comparisons as well as answer questions like: “Am I doing as many sealants or crowns as other practices in my area?”
“I encourage dentists to explore the idea of participating in a data warehouse to help understand medical and dental integration and develop decision support tools that provide better care for patients,” Jurkovich said.
Source: Power, Rhett. “The Challenge in Standardizing Electronic Healthcare Records (EHR). Where Is Progress Being Made?” Forbes, 23 Nov. 2022, forbes.com/sites/rhettpower/2022/11/23/ the-challenge-in-standardizing-electronic-healthcare-recordsehr-where-is-progress-being-made/?sh=3114d72964b1.
Krive, MBA, MS, PhD, clinical associate professor of biomedical and health information sciences at the University of Illinois at Chicago.
The growing players in healthcare EHRs — led by Epic, Oracle Cerner and MEDITECH— offer different types of cloud-based offerings at varying price points, said Krive.
“The market is generally divided by price and scope,” Krive said. “Epic and Oracle Cerner are the top choices for large, corporate healthcare entities. MEDITECH,
Allscripts [now known as Veradigm] and Centricity are in the middle market and serve individual hospitals or multi-practices in the dental world. Then you have eClinicalWorks and NextGen Healthcare with solutions for solo practitioners.”
When companies across industries began moving to the cloud in 2016, healthcare initially hesitated over security and Health Insurance Portability and Accountability
Act of 1996 (HIPAA) compliance concerns. But EHR software and cloud computing have matured to the point where data security and compliance have become among the main assets of cloud-based EHRs. To ensure all data is stored, shared and managed in a HIPAAcompliant way, service providers must work with healthcare organizations on liability terms and have disaster recovery plans in place.2,4 The major players in healthcare EHR are also certified by the Office of the National Coordinator
Like any business decision, transitioning your data to the cloud takes due diligence when it comes to deciding which company or companies to use. The questions below will help you better understand how an EHR vendor’s services will be provided and give you the peace of mind that the company is reputable and the right fit for your practice.
Questions for vendors:
• What EHR technologies are being utilized by dentists who have practices similar to mine?
• Where will my data be stored?
• What are some ways I can take advantage of the benefits of cloud-based EHR data?
• What is the most downtime I should expect?
• Do you have an out-of-the-box cloud solution based on partnership with a cloud technology provider?
• What other services or vendors may I use with your EHR platform, and how will other service or vendor data be integrated with my EHR solution?
• How can I ensure my patients’ data will be secure using this system? Does your company have a history of data breaches, and, if so, how were they addressed? • •
Questions to ask yourself:
• Does my practice have unique technology innovation or clinical trial needs requiring a custom EHR solution?
• Am I looking to get into AI and other cutting-edge technology innovations in the next few years, which may require dynamic hardware infrastructure capabilities offered by the cloud?
• Do I expect significant expansion of technology needs, in terms of adding many new patients (patient records), investing in the latest imaging solutions requiring more storage, or augmented AI assisting me with diagnoses in complex cases?
• Does the agility of adopting the latest technology innovations and changes matter to me? If my EHR vendor releases a new module or application, will I want it quickly?
• How can I ensure I am protected against patient privacy and data loss breaches? Do I have proper legal assistance to sign appropriate HIPAA business associate agreements with my EHR and cloud vendors?
for Health Information Technology, Jurkovich said, enhancing the potential for compliance.
Viewing patient data from a mobile device is one of the exciting capabilities of cloud technology, but it may raise HIPAA concerns. Companies are leveraging the convenience of mobile while making it HIPAA compliant by developing phone applications that have virtual protection boundaries, Krive said.
From a physical security standpoint, cloud-based EHRs are also stored and/or backed up offsite. That means if the office is impacted by theft, fire or another natural disaster, data is safe.
Healthcare systems are also seeing lower IT costs as a result of the transition to the cloud, largely driven by no longer needing to invest in physical storage or costly
onsite servers. The need for IT staff is also reduced because the third-party provider manages all the technology infrastructure on behalf of the healthcare organization.2,4
The cloud also offers healthcare organizations greater flexibility through its ability to instantly scale capacity.
“If you decide to partner with another practice, your volume has magically grown, or if you do more imaging, traditionally you would hit limitations on the server, and you would need to dump it before it goes through its normal lifecycle and get a newer one,” Krive said. “You escape this by partnering with a cloud provider. So, if you have to store more images and require more storage, you just need to agree on a price, and you can instantly start using more. You don’t need to worry about hardware upgrades or replacements
or waiting for a new server to arrive. You simply remove the entire hardware layer from your list of worries.”
The virtually unlimited nature of cloud-based EHRs substantially lowers the barrier for healthcare organizations to analyze greater volumes of data and leverage AI for clinical decision support.
“Those technologies require a lot of access to data, which requires a lot of storage and flexibility with computational power needs,” Krive said. “It is very difficult to implement something like that in the more limited physical environments. Oftentimes, those who are considering a jump to AI prefer to do so within the flexible and dynamic cloud environment. A jump to AI may come with a jump to the cloud, although the two are not a package.”
Along with AI, Google Health is another powerful tool that can be incorporated into EHRs, Zuckerberg said.
“Google Health is a huge, linked database for medical terms, and doctors who are part of a cloud-based EHR that syncs with Google Health have the ability to pull into the patient record all kinds of resources related to the disease the patient has,” Zuckerberg said. “We are not too far away from integrating some version of AI into a cloud-based EHR that allows practitioners to aptly use it in their decision-making tree about what the proper course of therapy is.”
Cloud-based EHRs boast a long list of benefits, but there are drawbacks. Downtimes can cause interruptions.4 Another issue is internet availability/speeds. If you live in a rural area or have frequent internet connectivity issues, that can disrupt your ability to access your data, Krive said.
As cloud technology has improved, the downsides have decreased. The limitations, Krive said, have less to do with cloud technology and more to do with cloud technology providers. Some people feel a loss of control over their data when transitioning to the cloud since it’s being managed or stored remotely. Knowing your cloud provider is the way to ease those concerns. (See “Evaluating EHRs” on page 16.)
“Do not partner with a company that doesn’t have expertise in storing patient and provider records,” Krive said. “You need to understand all costs up front, additional services that may be billed and the limits of your provider’s ability. You don’t want to be surprised if you want to expand and need greater access. Ensure all the benefits of cloud technology are actually available to you with the partner you choose.”
A 2022 study found that it typically takes 10 days for a dentist to receive EHR data from a physician. However, 13.8% of requests weren’t returned for over 30 days, and seven requests took over 100 days to be returned.6
When so much of healthcare has moved to the cloud, and clinicians across specialties are able to collaborate seamlessly, why is dentistry still separated?
Cloud-based EHRs are not prevalent in dentistry, Krive said, but they’re moving in that direction.
Two major healthcare organizations on the West Coast are a potential sign of how dentistry might leverage the interoperability power of EHRs to collaborate with other providers, both within and outside dentistry, to provide a more optimal level of patient care.
The University of California, San Francisco (UCSF), was among the first academic health institutions in the country to combine the records of its medical and dental patient encounters into one EHR system in December 2022.7
Michael Reddy, DMD, DMSc, dean of the UCSF School of Dentistry, explained how the university’s consolidation of medical and dental records has affected patient outcomes.
“The integration of medical and dental records on one platform has greatly improved the speed and efficiency of referrals within our system,” Reddy said. “This has allowed patients to get the care they need faster, which is especially important
for certain patients. Take, for example, cancer patients. Their treatment can’t begin until they have a dental clearance, and when we’re dealing with a serious condition like cancer, every day counts. We know that our unified EHR has improved the availability and accuracy of medication information. This has been especially useful for our dentists, who now have a more complete picture of their patients that they use to optimize their treatment approaches and avoid unintended outcomes due to medication interactions.”
Pacific Dental Services, a DSO, also completed an EHR integration, converting 9.7 million patient records to Epic and spending almost 16,000 hours on EHR training for about 14,000 team members and clinicians. Pacific Dental Services providers can now review a patient’s dental history along with their medical history in one record.8
The ability to collaborate and integrate with all types of healthcare providers through cloud-based EHRs doesn’t just make things easier and improve patient care and experiences — it raises the profession of dentistry, Zuckerberg said.
“Over the years, dentistry has been separate from medicine,” Zuckerberg said. “The mouth is part of the body, and diseases of the mouth have implications for the whole
“
”
Healthcare of the future will be more connected and coordinated, and dentists will not remain siloed from the rest of the patient’s healthcare team.
— Michael Reddy, DMD, DMSc
body. Dentists should be considered oral health specialists within the medical team.”
What would it take for dentists to make the leap to the cloud? With the technology still relatively new, dentists may need further proof that it’s safe and worth the cost, said Callan D. White, DDS, who practices at Asheville Family Dentistry in Asheville, North Carolina, and is a member of AGD’s Dental Practice Council.
“Dentists would be more apt to use a cloud-based electronic dental record (EDR) if they could see the benefits of EDR and EHR interoperability, if switching would be less expensive, and if the security/privacy risks were mitigated,” White said.
White pointed to research the American Dental Association (ADA) is conducting, which should shed light on the true benefits of medical-dental interoperability and where cloud-based technology improvements need to be made.
But, as dentists wait for that research to be released, White said practices need to weigh the cost and security decisions heavily.
“Cost is always going to be a concern, but, if the cloud-based platform is less expensive, I can see it being an easier sell to practice owners,” White said. “Due to the extensive policies and standards that offices must adhere to and the associated penalties and repercussions from an incident, security is extremely important for a lot of practitioners, especially larger medical and
dental corporations. Dentists will have to evaluate if a cloud-based EDR is practical, if it presents a cost benefit and if it is safe.”
Cost is a major driver of whether a general dentist switches to a cloud-based system, but, when weighing cost and security, the higher cost option may be the right choice if it’s associated with a trustworthy, credible vendor, Krive said.
“The best way is to partner with an EHR vendor and jump on those solutions that are proven, even if sometimes it may mean a higher-cost than the general market, because they’ve already tested their EHR with a specific cloud partner and have people who are knowledgeable in the technical complexities to keep it reliable,” Krive said.
Security is a major focus when transitioning to the cloud. Fortunately for dentists, most cloud-based dental systems have the advantage of using only the latest release, Jurkovich said.
“This really simplifies maintenance and upgrades for the vendor, thereby controlling costs,” Jurkovich said. “For cloud-based EDRs, the advantage for the dentist is that anytime something is upgraded, the system shuts down for that upgrade, so you’re always using the latest version. For localbased systems, you can be operating on an older system and still use the technology, which can be a security risk.”
The other question dentists may ask is
whether their practice would really benefit from a cloud-based EDR. It’s clear why a major health system or DSO would take advantage of the benefits, but does the same hold true for a solo practice owner?
To White, the major benefits of cloudbased records are likely seen by the larger, multi-practice dental corporations.
“That’s because of the ability to readily share patient information across multiple locations and the financial benefits of being able to distribute the associated costs across a broader network,” White said.
But others, including Reddy and Krive, think transitioning to cloud-based EHRs has benefits for all dentists.
“Healthcare of the future will be more connected and coordinated, and dentists will not remain siloed from the rest of the patient’s healthcare team,” Reddy said. “It will therefore be important for dentists to have an EHR system that connects into the rest of the healthcare system. Interoperability and the ability to share data for care coordination is important.”
Adopting new ways of doing business can be challenging, and cloud-based EHRs present a lot of unknowns to dentistry right now. But, like any new technology, it will probably eventually prevail, Krive predicted.
“Nearly all healthcare organizations are already somewhat in the cloud or at least making plans to jump into the cloud,” Krive said. “Twenty years ago, providers argued about leaving paper to go to EHR. Everyone will be in the cloud — it’s just a matter of when and how.”
According to Zuckerberg, even the smallest dental practices could benefit from a more streamlined, integrated EHR system. He recalled his own journey to modernizing his practice, which started with a routine doctor’s visit in 2004. A medical associate spent 10 minutes flipping through a paper chart the size of an encyclopedia, unable to find the information he was seeking. That night, Zuckerberg decided his own private dental practice would go paperless.
“Dentists will have to evaluate if a cloud-based EDR is practical, if it presents a cost benefit and if it is safe.
”— Callan White, DDS
Siwicki, Bill. “Meditech Highlighting Google Health Integration and Cloud EHR at himss23.” Healthcare IT News, HIMSS Media, 17 Apr. 2023, healthcareitnews.com/news/meditech-highlighting-googlehealth-integration-and-cloud-ehr-himss23.
“ADA Dental Experience and Research Exchange (DERE)™.” American Dental Association , ada.org/resources/research/ dental-experience-and-research-exchange.
“BigMouth Dental Data Repository.” Consortium for Oral Health Research and Informatics, bigmouth.uth.edu/.
Nelson, Hannah. “Healthcare Orgs Tap Cloud-Based Meditech Expanse EHR for Interoperability.” EHR Intelligence, TechTarget, Inc., 7 Nov. 2022, ehrintelligence.com/news/healthcare-orgs-tapcloud-based-meditech-expanse-ehr-for-interoperability.
Hayhurst, Chris. “‘A Better Long-Term Solution’: How Health Systems Keep Workloads in the Cloud Secure.” Technology Solutions That Drive Healthcare, 15 Feb. 2023, healthtechmagazine.net/article/2023/02/better-long-termsolution-how-health-systems-keep-workloads-cloud-secure.
Patel, Kiltesh. “Council Post: How the Rapid Consolidation of the Dental Industry Might Impact Your Health.” Forbes, 23 Feb. 2023, forbes.com/sites/forbestechcouncil/2023/02/23/ how-the-rapid-consolidation-of-the-dental-industry-mightimpact-your-health/?sh=912f3391679c.
Giesecke, Eric. “Is Your Dental Practice Delivering What Patients Expect?” Dental Products Report, 23 Aug. 2022, dentalproductsreport.com/view/ is-your-dental-practice-delivering-what-patients-expect-.
“At that point, I had 23 years of insurance forms and medical histories and 17 years of film radiographs in my office,” Zuckerberg said. “I thought every now and then about an office that had a fire or flood that damaged everything.”
With the help of his son-in-law, Zuckerberg built a custom software solution that allowed his office to function better.
“By 2007, everything was easier to find, and I had no fire or flood fears,” Zuckerberg said. “We used Apple’s Time Machine that updated data every hour, and we backed up our data to the cloud at the end of each day. The worst catastrophe would be the loss of one day’s data. It helped me sleep better and run a much more efficient practice.
Practices that move to the cloud are finding that now.” F
1. “Aspen Dental Cybersecurity Breach: Immediate Actions Dental Practices Must Take to Prevent Similar Risks.” Darkhorse Tech, darkhorsetech.com/blogs/aspendental-cybersecurity-breach-immediate-actions-dentalpractices-must-take-to-prevent-similar-risks. Accessed 16 May 2023.
2. Laha, Niloy. “Rethinking Healthcare ERPs Using CloudBased Platforms.” Grant Thornton LLP, 28 March 2023, grantthornton.com/insights/articles/health-care/2023/ rethinking-healthcare-erps-using-cloud-based-platforms.
3. “70% of Healthcare Businesses Have Adopted Cloud Computing: DuploCloud Report.” GlobeNewswire News Room, 22 Feb. 2023, globenewswire.com/newsrelease/2023/02/22/2613339/0/en/70-of-HealthcareBusinesses-Have-Adopted-Cloud-Computing-DuploCloud-Report.html.
4. LaPointe, Jacqueline. “From Head in the Clouds to On the Ground Cloud-Based Revenue Cycle Management.” RevCycleIntelligence, 6 Sept. 2022, revcycleintelligence.com/ features/from-head-in-the-clouds-to-on-the-groundcloud-based-revenue-cycle-management.
5. Landi, Heather. “HLTH22: Google, Epic Ink Deal to Migrate Hospital EHRs to the Cloud to Ramp up Use of AI, Analytics.” Fierce Healthcare, 16 Nov. 2022, fiercehealthcare. com/health-tech/google-epic-ink-deal-migratehospital-ehrs-cloud-ramp-use-ai-analytics.
6. Li, Shuning, et al. “Retrospective Study of the Reasons and Time Involved for Dental Providers’ Medical Consults.” Frontiers, 12 May 2022, frontiersin.org/articles/10.3389/ fdgth.2022.838538/full. Accessed 16 May 2023.
7. Nelson, Hannah. “UCSF Looks to EHR Integration of Dental Records for Patient-Centered Care.” EHRIntelligence, 21 Feb. 2023, ehrintelligence.com/features/ucsf-looksto-ehrintegration-of-dental-records-for-patient-centered-care.
8. Rodriguez, Sarai. “Nearly 900 Dental Practices Complete Epic EHR Implementation.” EHRIntelligence, 29 Aug. 2022, ehrintelligence.com/news/nearly-900-dentalpractices-complete-epic-ehr-implementation.
Subject Code: 567
The 10 questions for this exercise are based on information presented in the article, “Moving Electronic Health Records to the Cloud” by Kelly Rehan, on pages 12–19. This exercise was developed by members of the AGD editorial team.
Reading the article and successfully completing the exercise will enable you to:
• understand the pros and cons of cloud-based electronic health records (EHRs);
• learn how the technology behind cloud-based EHRs works; and
• evaluate whether cloudbased EHRs are a good fit for your practice.
This exercise can be purchased and answers submitted online at agd.org/self-instruction
Answers for this exercise must be received by July 31, 2024.
1. In _____, Aspen Dental, which has more than two million patient dental records, announced that a cybersecurity event affected all of its more than 1,000 practices.
A. December 2022
B. February 2023
C. April 2023
D. June 2023
2. A 2023 study of 500 healthcare IT professionals found that Medicare and Medicaid facilities (91%) and hospitals (90%) had the highest cloud-based technology adoption rates, while dental practices (_____%) had the lowest. Doctor’s offices were at _____%.
A. 24; 38
B. 23; 37
C. 22; 36
D. 21; 35
3. In terms of EHRs, “moving to the cloud” means that healthcare facilities use _____ to store and manage their data, and they access that data through _____.
A. off-site servers; the internet
B. off-site servers; Bluetooth
C. on-site servers; the internet
D. on-site servers; Bluetooth
4. When companies across industries began moving to the cloud in_____, healthcare initially hesitated over security and Health Insurance Portability and Accountability Act of 1996 (HIPAA) compliance concerns.
A. 2015
B. 2016
C. 2017
D. 2018
5. To ensure all data is stored, shared and managed in a HIPAA-compliant way, service providers must work with healthcare organizations on liability terms and have _____ in place.
A. data backup procedures
B. information sharing strategies
C. disaster recovery plans
D. priority access levels
6. The major players in healthcare EHR are also certified by the Office of the National Coordinator for _____, enhancing the potential for compliance.
A. Data and Information Management
B. Health Information Technology
C. Electronic Health Data
D. Health and Technology Management
7. A 2022 study found that it typically takes _____ days for a dentist to receive EHR data from a physician. However, _____% of requests weren’t returned for over 30 days, and seven requests took over 100 days to be returned.
A. 7; 16.8
B. 8; 15.8
C. 9; 14.8
D. 10; 13.8
8. Which of the following was the first academic health institution in the country to combine the records of its medical and dental patient encounters into one EHR system?
A. University of California, San Francisco
B. University of Pennsylvania
C. Oregon Health Sciences University
D. University of Texas Health Science Center at Houston
9. _____, a dental services organization, also completed an EHR integration, converting 9.7 million patient records to Epic and spending almost 16,000 hours on EHR training for about 14,000 team members and clinicians.
A. Midwestern Centers for Dental Services
B. Integrated Dental Healthcare
C. Pacific Dental Services
D. Community Dental Care Centers
10. _____ leverage large volumes of data that are shrunk into smaller groups, helping guide clinicians in the right direction.
A. Carrier clouds
B. Data warehouses
C. Storage hubs
D. Information databases
Achieving effective and efficient communication among all members of a dental team is one of the most important aspects of any successful practice. I know that statement isn’t exactly a surprising or shocking revelation — but, then, why does stellar communication remain so elusive an achievement in many dental practices? There are many answers to this question. Communication techniques and strategies differ based on a slew of different aspects, such as the size and attributes of the practice, the message content or topic, the target audience, the level of urgency, and whether the communication is planned or spontaneous.
Following are a few of my current favorite communication strategies, technologies and philosophies. It is my hope that, even if they are not directly applicable to your specific practice, they might stimulate discussion and bring you and your team closer to achieving effective and efficient communication.
Implementing walkie talkies into the daily fabric of my practice was something I’d long considered but never got around to executing until the COVID-19 pandemic. The efficiency and elegance of everyone being microphoned up was always appealing. No more searching for a specific coworker when you need them. No more running to the storeroom for additional supplies when you need something. No more bombarding the front desk staff with a lengthy list of questions posed by the patient about insurance and financial arrangements during their appointment. Instead, the entire staff and their knowledge base is accessible with the push of a button. Information is transferred cleanly and quickly. In addition to the aforementioned communication benefits, we used the walkie talkies to help with “air traffic control” during the pandemic, which minimized physical patient interaction in the hallways and at the front
desk during checkout. Walkie talkies work great in every aspect we envisioned. We use Motorola units with earpieces to keep conversations private from patients. It’s a similar setup to many police and security details. Physically sending a staff member to deliver a message to another person is extremely inefficient and time-consuming. Even sending the message through the practice management software messenger is inefficient because it takes time to type out. Most conversations are easily relayed via the walkie talkies while maintaining a top-tier professional decorum. They’ve been great additions to our practice and have certainly helped increase communication efficiency and quality among our team.
As the father of four children who participate in a lot of sports teams, messaging apps are part of the normal fabric of my daily parenting life. Apps such as GameChanger,
TeamSnap and GroupMe allow players, parents and coaches to not only share messages, but also take advantage of other features, such as livestreaming game video, shared calendars, photos and opinion polls. Rarely are emails used, and I can’t even recall the last time we were part of a teamwide text thread. These apps do everything the emails and texts did and more. For example, when the coach has to change a practice location, we’ll get an updated calendar listing as well as a notification in the message thread. Since these are sent via push notifications to my phone, they are separated from the other dozens or hundreds of text and email threads we all receive daily, which in turn increases the likelihood that I’ll read them and drive my child to the correct practice location. It’s extremely efficient and effective communication, which is why my dental team uses an app to communicate when we’re out of the office. In the rare instance the practice needs to announce important or official information, it is still disseminated via email, but, for day-to-day conversations, the app has been well received. Calendars, announcements, polls, photos and more all are used by the staff and with great ease. After all, a dental team at its core is no different from any sports team.
At our practice, the morning huddle is the cornerstone of the entire workday. For years, we used to sit around the breakroom table with our coffee and verbally discuss the day’s schedule. It was adequate and worked acceptably, but, last year, we “leveled up” the effectiveness of the meeting with one incredibly simple change. Rather than verbally running through a printed schedule, I now lead the huddle using my laptop connected to a large TV mounted on the wall. This allows the team to verbally review the scheduled patients and procedures as before while also incorporating a new visual aspect. For example, while I discuss the scheduled crown on Mr. John Doe that afternoon, I can display past intraoral photos taken that show the recurrent decay, radiographs that show the large volume and proximity to the pulpal horn, pertinent medical history topics, and scanned lab
slips of previous crowns to aid and prepare for shade selection. Incorporating the visual aspect into the morning huddle has yielded a tremendous increase in individual preparedness for each appointment. The clinical team has a more complete understanding of each proposed procedure and how it is expected to occur. The nonclinical team is better prepared for insurance submissions and scheduling because they understand more clearly what the clinical team will be attempting to accomplish that day. Additionally, the clinical team gains better understanding and appreciation of what documentation is desired and used by the nonclinical team once the treatment has been completed. Since incorporating the laptop and TV in the huddle, every member of our team is more knowledgeable and prepared for the day than ever before. By starting off on the same page and having more in-depth knowledge of the tasks at hand, each team member can adapt as needed when a decision is to be made or when the inevitable surprise comes up.
A lesson that new dental practice owners and managers often discover quickly is that it’s quite easy to implement or begin new procedures, protocols and projects, but quite a challenge to consistently follow up and manage these edicts over time. How do you remember to follow up with staff on these new updates? How do staff members remember them? It’s certainly no easy task on either side of the coin. Over the nearly 50-year history of our dental practice, a slew of different methods have been used to achieve this, and we’re still improving. Years ago, the spiralbound notebook and sticky note were our favorite tools. Then, spreadsheets and word processor documents found their way into the mix. Whiteboards were the next big iteration, and there were a lot of them! All of these were effective but had limitations such as portability, shareability and the lack of automation. Currently, our team uses various forms of digital project management software to sort, remember and follow up with all the items on their to-do lists. There are many to choose from, but most share similar features. A few examples
are Microsoft Teams, Asana and Monday. Like the messaging apps, these programs can do everything the previous methods could do and more. Personally, I find the automation to be the largest improvement. Setting reminders to follow up on projects is so helpful, especially when you’re spinning all the plates that a dentist and small business owner spins. It’s almost like everyone has their own personal assistant to remind them of important items like projects and due dates. Progress can be tracked within the programs to monitor employee accomplishments as well. It has been a highly effective addition to our practice and has increased communication among team members quite remarkably.
Effectively harnessing the power of your dental practice’s social media is absolutely one of the greatest staff communication tools at your disposal. On the surface, social media is geared toward externally marketing to potential patients as well as existing patients, but it’s also a wonderful way for your staff to learn and share about what’s going on in the practice. For many midsize and larger dental practices, it is not logistically possible to have regularly scheduled staff meetings with every employee in attendance. Not all employees work the same days or hours, and some might be on vacation or absent for any number of reasons. Employees who actively follow the practice’s social media will always be plugged into its current goings-on. They’ll be able to directly reference posts to patients about topics as they come up, which in turn drives more traffic to your sites. It’s a very positive feedback loop that can help elevate your practice to higher levels.
The road to effective and efficient communication among staff members is unique to every dental practice. I hope these strategies, technologies and philosophies stimulate conversations and ideas within your workplace and prove useful to you and your team. F
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Rebekkah Merrell, DMD Charlotte, NC Member since 2016